Abstract
Most patients with very advanced cancer suffer from severe pain, and many studies have demonstrated how this pain can be sufficiently controlled. It is of great importance to find out if the findings are also true during the final stage of cancer and how the treatment must be adapted. We therefore examined the methods and efficacy of providing pain relief for dying cancer patients. This study included 160 patients with cancer in different sites. The pain treatment and pain severity during the last few days and hours of their lives are described and discussed. Analgesic drugs administered orally in 53% and parenterally in 39% of the patients were the mainstay of therapy. Non-opioid analgesics alone were effective in 10% and in combination with weak opioids in 15% of the patients. In 68% strong opioids were necessary to achieve sufficient pain reduction. Morphine was the most frequently used opioid for 96 patients. Oral doses of morphine were 86±60 mg/day (15–240 mg/day), and parenteral doses 89±74 mg/day (15–360 mg/d). Additional adjuvant drugs to treat specific types of pain or other symptoms of cancer disease were described for 80% of the patients. Non-pharmacological measures, such as radiation, nerve blocks or neurosurgery, were of no real importance. Only 4% of the patients treated in the way described experienced severe pain during the final stage of cancer. Systemic administration of drugs is very effective in relieving pain in dying patients. No signs of tolerance to opioids could be observed, even in patients who had been taking opioids for a longer period of time (average 39 days).
Zusammenfassung
Starke Schmerzen sind für viele Patienten mit fortgeschrittenen malignen Erkrankungen das am meisten belastende Symptom. In vielen Publikationen ist gezeigt worden, wie diese Schmerzen effektiv behandelt werden können. Es ist von großer Bedeutung herauszufinden, ob dies auch für die finale Phase der Erkrankung gilt, und welche Anpassungen erforderlich sind. Deshalb wurde retrospektiv untersucht, mit welchen Methoden und welcher Wirksamkeit tumorbedingte Schmerzen bei sterbenden Patienten behandelt werden können.
Für 160 Patienten mit malignen Erkrankungen der verschiedenen Organsysteme werden die während der Stunden und Tage vor dem Tod durchgeführte Schmerztherapie und die darunter gemessene Schmerzintensität dargestellt und diskutiert. Im Vordergrund der Therapie stand die systemische Gabe von Analgetika, welche 53% der Patienten oral und 39% parenteral erhielten. Nichtopiathaltige Analgetika alleine waren bei 10% und in Kombination mit schwachen Opiaten bei weiteren 15% der Patienten ausreichend. Über zwei Drittel benötigten jedoch in der Finalphase starke Opiate. Das Opiat unserer Wahl war bei 96 Patienten Morphin. Der tägliche Morphinbedarf lag oral bei 86±60 mg (15–240 mg) und parenteral bei 89±74 mg (15–360 mg). 80% der Patienten erhielten zusätzlich adjuvante Medikamente zur Behandlung spezieller Schmerzformen oder zur Linderung anderer Krankheitssymptome. Verfahren, wie Bestrahlungen, Blockaden oder neurochirurgische Operationen, spielten in der Finalphase keine große Rolle. Unter dieser Therapie litten nur 4% unserer Patienten präfinal unter starken Schmerzen. Die systemische Pharmakotherapie ermöglichte also eine gute Schmerzreduktion beim Sterbenden. Auch nach längerer Anwendung (durch-schnittlich 39 Tage) hochpotenter Opiate wurden keine Anzeichen für eine Toleranz beobachtet.
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Grond, S., Zech, D., Horrichs-Haermeyer, G. et al. Schmerztherapie in der Finalphase maligner Erkrankungen. Schmerz 4, 22–28 (1990). https://doi.org/10.1007/BF02527826
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DOI: https://doi.org/10.1007/BF02527826